Fibromyalgia (FM) is a chronic syndrome defined by widespread pain, cognitive dysfunction, sleep dysfunction and fatigue. Cognitive behavioral therapies (CBTs) are often a recommended treatment for Fibromyalgia. It is in fact a psychological treatment used in many chronic pain conditions as well as other health problems such as depression and anxiety. CBTs are a method of improving a person’s beliefs about their illness and their abilities and helping to develop ways to cope with health issues. The main idea of CBTs are to change negative thoughts and feelings the people can have about their physical, mental and emotion states and to then adapt their behaviors from that. People may learn such skills as pacing and relaxation to manage pain or they may alter their attitudes about their pain to gain more acceptance. It has been often used and recommend for FM but has it been effective?
Review of CBTs Studies
An analysis of studies done on CBTs was reviewed to see the overall effectiveness of the treatment. The sampling they took was from: “We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1966 to 28 August 2013), PsycINFO (1966 to 28 August 2013) and SCOPUS (1980 to 28 August 2013). We searched http://www.clinicaltrials.gov (web site of the US National Institutes of Health) and the World Health Organization Clinical Trials Registry Platform (ICTRP) (http://www.who.int/ictrp/en/) for ongoing trials (last search 28 August,2013), and the reference lists of reviewed articles.” They selected randomized controlled trials with children, adolescents and adults. The data within these studies was extracted and the risk of bias within the studies were assessed independently by two review authors. Any discrepancies were resolved by discussion. There were a total of 23 studies included with 2031 patients; 1073 in CBT groups and 958 in control groups.
Conclusions of CBT review
The review study stated CBT for fibromyalgia provided “ a small incremental benefit over control interventions in reducing pain, negative mood and disability at the end of treatment and at long-term follow-up.”
After 12 weeks of CBT children, adolescents and adults with FM reported:
- -May reduce slightly pain, negative mood and disability at the end of the treatment
- -May reduce slightly pain, negative mood and disability six months after the end of treatment.
- -People who used CBTs rated their pain to be 0.5 points lower at the end of treatment and to be 0.6 points lower six months after the end of treatment on a scale of 0 – 10. Those who used CBT rated their pain on average 6.9 on a scale of 10. Those on a control treatment 7.4 on a scale of 10.
- -People who used CBTs rated their depressed mood to be 0.7 points lower at the end of treatment and to be 1.3 points lower six months after the end of treatment on a scale of 0 – 10. Those who used CBT rated their negative mood to be 6.1 on a scale of 10. People who used a control treatment rated their negative mood 6.8 on a scale of 10.
Why people with FM might not show more improvement with CBT treatment
There was a study done with evaluating why some people do well with CBT treatment with depression and others do not. It determined those who respond well to CBT treatment have lower insula activity in the brain and those with higher insula activity responded better to an antidepressant (Lexapro). FM patients often have increased insula activity in the brain and that might account for why CBT is not as effective. The “Insula activity predicted who responded best to either of the treatments. Those who found relief from talk therapy tended to have reduced activity in this area before treatment, compared with activity in other parts of their brain. “Low activity in the insula at baseline may reflect impaired sensitivity to signals [of] one’s internal state,” says Dr. Helen Mayberg, professor of psychiatry, neurology and radiology at Emory University and the lead author of the study, suggesting that this may make people unduly focused on negative experiences like rejection.” (Time Health & Family) And “CBT, however, teaches patients that their initial perceptions are just thoughts and that a more positive interpretation of their first, and gloomy perceptions, is possible. So those with lower insula activity may benefit from this active reframing of their environment, since it helps to divert their attention away from the negative thoughts and emotions that have become their primary focus.” (Time Health & Family)
Cognitive behavioral therapies CBT treatment while often recommended for the treatment of Fibromyalgia seems to have only small improvements on pain and mood. However it can be beneficial to some people and certainly where comorbid depression or anxiety is a factor results might varying depending on the individual. It does appear that CBT treatments might be more effect for those with lower insula activity but that cannot be simply determined and therefore it is a treatment people might want to try. Certainly seeing a psychologist and trying different sorts of pain management strategies can help assist a person enhance their coping skills either with or without medication. There is no right answer for each individual.
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